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Full text of "Report No. 9, Report on the Shortages of Dental Personnel in North Carolina"

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Report No« 9 



REPORT ON 

THE SHORTAGES OF DENTAL PERSONNEL 

IN NORTH CAROLINA 



f> ^ 

4 North Carolina 

y^ Legislative Research Commission 

Raleigh 

1967 






V 



i 

1*1 









Tx\BLE OF CONTENTS 

Page 
Introduction 1 

Findings 2 

Reconmiendations 4 

Appendices : 

A. Draft of Bill Appropriating $1,100,000 to 
the University of North Carolina for the 
Fourth Floor of the Dental Education Wing. . 5 

B* Resolution Directing Commission to Study- 
Matters Relative to Shortages in Medical 
Professions . 6 

C. Report of the Subcommittee Assigned to 

Study Shortages in Dental Personnel 7 

D. Minutes of the Public Hearing Held by 
the Subcommittee Assigned to Study 
Shortages in Dental Personnel 11 

E. Report of Dean James W. Bawden on the 
Dental Education Wing at the School of 
Dentistry, University of North Carolina at 
Chapel Hill 22 

F. Report of the Dental Assistants Committee, 
North Carolina Dental Society 29 

G. Report of the Dental Hygienists Committee, 
North Carolina Dental Society 30 

H. Report of Dental Auxiliary Personnel 

Education Programs by the Department of 
Community Colleges 32 



i 

■A' 









Introduction 






An unnumbered House resolution adopted June 15, 1965, 
directed this Commission to study "matters relating to the 
\ current shortages existing in technical or professional 

personnel in the field of medical services and the projected 
needs of the State in this field." The study was to include 
information regarding dental hygienists and dental assistants 
as well as other health career programs. (See Appendix B) 

The Commission undertook the dental auxiliary phase 
of the study by requesting information from appropriate persons, 
agencies, organizations and associations connected with dental 
services. Hearings were held by a subcommittee of the Commis- 
sion (See Appendix D) and some presentations were made before 
the full Commission. The subcommittee toured the facilities of 
the School of Dentistry at the University of North Carolina 
at Chapel Hill. 

The Commission adopted the report of the subcommittee 
(See Appendix C) and made the following findings and recommend- 
ations with regard to shortages of dental personnel in North 
Carolina. 



.1- 



Findings 

There is and will continue to be an unprecedented 
demand for dental care services in North Carolina. 

it is the duty of the State to insure that trained 
dental personnel are available to meet the needs. There are 
at present no programs in North Carolina to prepare dental 
personnel other than at State-supported institutions. Train- 
ing is offered at the University of North Carolina at Chapel 
Hill and at some units of the Community College System. 

There are critical shortages of dental hygienists 
and dental assistants in the State. The shortage of dental 
laboratory technicians does not appear to be critical at the 
present time. 

A most acute need is for the education and training 
of instructors to train dental auxiliaries, since it is only 
with the increased capacity and number of facilities staffed 
with adequately prepared instructors that the shortages of 
dental hygienists, dental assistants, and dental laboratory 
technicians can be met. 

The only facility in the State which is now pre- 
paring personnel to train dental auxiliaries is the Dental 
School at the University of North Carolina at Chapel Hill. 
Expansion of the training programs there will be accomplished 
by the planned construction of a Dental Education Wing. Because 
of insufficient funds, one floor of the building as originally 



-2- 



designed has been eliminated and the training program plans 
have been correspondingly reduced. The Commission finds that 
in order to meet the dental education needs of the State, 
additional funds are needed to restore the floor to the 
building. 



Recommendations 
We recommend: 

1. That the General Assembly provide continued 
financial support for the existing university, 
senior college, community college, and technical 
institute programs for the training of dental 
hygienists, dental assistants, and dental labora- 
tory technicians*, 

2. That the General Assembly provide $1,100,000 to 
construct and equip the fourth floor of the Dental 
Education Wing to be built at the School of 
Dentistry at the University of North Carolina at 
Chapel Hill, in order to accomplish expansion of 
the following programs : 

(a) dental auxiliary training; 

(b) auxiliary instructors' training; 

(c) continuing education of practicing 
dentists 

(d) graduate training in dentistry* 



p^ 



^ ft 



Appendix A 



Draft of Bill Appropriating $1,100,000 to the University of 
North Carolina for the Fourth Floor of the Dental Education Wing 



A BILL TO BE ENTITLED AN ACT TO MAKE AN APPROPRIATION TO THE 
UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL TO CONSTRUCT AND 
EQUIP A FOURTH FLOOR IN THE DENTAL EDUCATION WING AT THE SCHOOL 
OF DENTISTRY. 
The General Assembly of North Carolina do enact: 

Section 1. There is hereby appropriated to the University 
of North Carolina at Chapel Hill out of the General Fund of the 
State the sum of one million one hundred thousand dollars 
($1,100,000) to be expended for the purpose of constructing and 
equipping a fourth floor in the Dental Education Wing at the 
School of Dentistry, This floor is to be used for the expansion 
of programs for dental auxiliary training, auxiliary instructors^ 
training, continuing education of practicing dentists, and 
graduate training in destistry. 

Sec, 2. All laws and clauses of laws in conflict with this 
Act are hereby repealed. 

Sec. 3. This Act shall become effective upon its ratification, 



Appendix B 



(HOUSE RESOMiTION 
A HOUSE RJESOLUIION DIBBCTINQ THE LEGISLATIVE COUNCIL OR ITS SfOGiSSOR TO 'a 



STUDY MATTERS REUTBTE TO SHORTAGES IN 14EDIGAL PROFESSIONS. 

Be it resolved by the House of Represoatatives ; 

Section 1* Tbe Legislative Council or its successor is hereby directed 
to study matters relating to the current shortages existing in tecbnical or 
professional personnel in the field of medical sei^ices and the projected 
needs of the State in this field. The study shall include information re- 
garding nursing programs, medical records technicians, dental hygienists, 
dental assistants, X-Ray technicians and other health career programs. The 
findings and recommendations of such study shall be reported to the 1967 
General Assembly. 

Sec. 2. This Resolution shall become effective upon adoption. 

[Adopted by the House of Representatives June 1$, 1965.] 

(Introduced By: Mr. Johnson ol Duplin) 









p ^ 



Appendix C 

Report of the Subcommittee Assigned to Study Shortages in 
Dental Personnel 

TO: THE LEGISLATIVE RESEARCH COMMISSION 

FROM; SENATOR THOMAS W SEAY, JR. AND SENATOR FRED K MILLS, JR. 
CHAIRMAN AND CO-CHAIRMAN APPOINTED TO STUDY THE FOLLOWING 
RESOLUTION: 

A HOUSE RESOLUTION DIRECTING THE LEGISLATIVE COUNCIL OR 
ITS SUCCESSOR TO STUDY MATTERS RELATIVE TO SHORTAGES IN 
MEDICAL PROFESSIONS. 

Hearing held April 16, 1966 

All of the testimony heard indicates there will be an 
unprecedented demand for dental care services. Every indication 
is that the Federal government will expand its medicare program 
to include dental services for children up to 6 years of age. 
Also the prepaid insurance programs now under consideration 
will increase the demand for dental services. The Public Health 
program in the schools is creating an awareness of the need 
for dental care for all of our school children. The increase 
in the number of pupils is evident. It is the duty of the State 
to provide trained personnel to meet the need of all the fields 
concerned. Too little has been done to provide this type of 
personnel not only in North Carolina but in the entire country. 
There is no lack of qualified candidates for the training 
facilities available . 

It is very obvious that there are no facilities other 



than state supported institutions to prepare these people for 
work in the dental health field. There is no prospect that 
private schools will enter into these fields in this State • 
The burden is directly on the Dental School at the University 
of North Carolina and with the Department of Community Colleges, 
Vocational Technical Division, From all available information 
received, the acute shortage lies in the absence of any train- 
ing facilities for instructors in the field of dental hygienists, 
dental assistants and laboratory technicians. Further that in 
the United States today, no school exists in which to prepare 
trained qualified instructors. These instructors must have not 
only the unique technical skills in this field but also the 
necessary education to meet the standards required by the 
various accrediting agencies. Presently, qualified instructors 
are being secured from retiring military personnel, but it can 
be easily recognized that this is a very limited source. To 
establish a school to train these instructors would involve a 
great expenditure; the amount as of this date undetermined. 
It is anticipated that expansion and development of a "work-shop*' 
training course under the auspices of the Dental School of the 
University of North Carolina is the only immediate and temporary 
solution. The development of an incentive scholarship program 
is another avenue provided accredited training courses could be 
found. 



^i 



> ¥ 



It is the conclusion of those concerned that con- 
tiiiued development of the dental hygienist program, will be of 
unparallel assistance in the field of public health. With the 
increase in the niunber of trained dental hygienists will come a 
reduction in the salaries which they presently command. ($600. 
to $700. per month) The General Assembly of 1965 made a con- 
siderable appropriation to implement the training of dental 
hygienists. 

The three schools presently training dental assistants 
are to be complimented on their programs. The need for trained 
dental assistants is pressing, and it has teen recommended by 
those present at the April 16, hearing that two more schools 
should be opened, the location being determined by the Depart- 
ment of Community Colleges with the cooperation of the North 
Carolina Dental Society. At this time, there appears to be no 
critical shortage of dental laboratory technicians and the pre- 
sent program at the Durham Technical Institute is performing 
competent service. 

The training programs in these fields, dental 
laboratory technicians, dental assistant education, dental 
hygienist education are new. Their expansion is necessary to 
the health and welfare of the people of North Carolina. They are 
only able to train the necessary personnel as qualified instructors 
in the fields become available. The education and training of 

9 



these instructors is the polestar for the proper solution^ 
The burcjen for proposing these training programs for instructors 
lies with the North Carolina Dental Society, University of North 
Carolina School of Dentistry, the University of North Carolina 
School of Education and the Department of Coimnunity Colleges 
as well as the General Assembly of North Carolina when such 
programs are proposed. 

These conclusions are in no way meant to limit the 
proposals for the solution of the problem oH tJkie increasing need 
for dental care. 



Thomas W. Seay, Jr. 



Fred M. Mills, Jr. 



10 



it 



ATTpendiy D 

April 16, 1966 - MINUTES ON DENTAL PHASE OF A HOUSE RESOLUTION 

DIRECTING THE LEGISLATIVE RESEARCH COMMISSION TO STUDY SHORTAGES 

IN MEDICAL PROFESSIONS, 

Senator Thomas Seay, Chairman 
Senator Fred Mills, Co-Chairman 

Senator Seay presided at the meeting which was held 
April 16, 1966 at 9:30 a.m. in Room 1118 of the Legislative Build- 
ing. Senator Seay opened the meeting by explaining to those present 
the motive behind the meeting and the duty of the Commission to 
report to the 1967 General Assembly with a recommendation on the 
Resolution. 

Dr. E> A. Pearson, Jr., Director, Dental Division State 
Board of Public Health, introduced Dr. James W. Bawden , incoming 
Dean, Dental School, University of North Carolina. 

D r. Bawdeh; Our primary responsibility at the University 
is dealing with the dental manpower needs of the State from the 
standpoint of education. The Dental School is the fountainhead of 
our source. It is important that ive have the opportunity to discuss 
our problems with you. 

What is the dental manpower situation in this State? 
The situation is critical. At the present time, the profession is 
barely meeting the demand, not the need for dental health. A 
greater and greater percentage of the people are going to demand 
dental health care because of the rise in our economy and the general 
affluence of society. Also, our population is increasing. About 

11 



40% of the population across the country receive dental health 
care. Of this 40%, one-half or less get adequate care but this 
picture is rapidly changing, because of Union Dental Health plans, 
Dental Insurance programs (pre-paid) and Federal Programs* Recent 
legislation proposed will involve 30 to 40 million children 
between the ages of 2 and 6, This will have a tremendous impact 
on the situation. All these things combined will probably raise 
this demand factor of 40% to 70% or 80%* 

There are 6 approaches for meeting this situation. 

(1) Educate more dentists. 

(2) Increase the productivity of the dentist by increasing the 
auxiliary dental personnel o Educate dentists to use dental 
auxiliaries. 

(3) Educate people to the cause of tooth disease and to use the 
preventive measures available. 

(4) Research to control the incidence of disease. 

(5) Continuing education of the practicing dentist. The man in 
the field must have the opportunity to come back to an 
environment where he can update his professioua 

(6) Graduate training to provide specialty training and to train 
teachers and those in research. 

What is the School's approach to these problems? 
(I) The University of North Carolina Dental School is listed 

fourth best in the nation. At the present time, our class 

is 50 a year. The Dental School since its opening and through 

12 



1965 has graduated 530, Seventy-one percent are located 
in North Carolina; 15^ go into the Armed Services, How- 
ever, we think a good percentage of these return to North 
Carolina. We are now in the process of expanding our 
facilities to accoiiunodate 75 students. Further expansion 
at this time is economically impossible. As it is we had 
to cut back the original plans of our new clinical and 
basic science wings because of the rise in construction 
costs from the time of planning to actual construction. 
The complete top floor had to be eliminated, limiting 
expansion in dental auxiliary training, auxiliary teachers* 
training program, continuing education of the practicing 
dentist and graduate training programs. 

(2) We are training, at maximum now in the field of auxiliary 
dental personnel without further expansion. Dental 
auxiliaries can increase effectiveness of a dentist as 
much as 100% if the dentist is trained to use auxiliary. 
Average increase in effectiveness is 50.^. The present 
population ratio of 4,000 to 1 dentist v/ill be con^slderably 
higher unless there is expansion. 

(3) Research is our one ace in the hole. Research will help 
reduce this demand factor. There have been exciting 
developments recently. The North Carolina Dental Society 
provided $350,000 so we could obtain Federal funds for a 

13 



new Research Building. This was a gift to the State of 
North Carolina* The State does not provide any funds for 
this purpose, and we must rely on Federal funds. This 
building is already 80^ committed and is a year away from 
completion. 

(4) Preventive education plays an important part in reducing 

the incident of disease. Research provided us with florida- 
tion and education is necessary to see that this preventive 
measure is used; also, topical application (8^ stannous 
fluoride, remaining solution distilled water) • Thirty-one 
percent of the population in the State is drinking treated 
water. Greensboro is the only large town left in North 
Carolina not treating water. This process reduces cavities 
by half. Wheh it is not possible to economically fluoridate 
the water (rural areas), the populace can be educated in the 
preventive topical application. It must be stressed again 
that practicing dentists must be educated to new research. 
This should be an important part of the curriculum of the 
Dertal School. 

We agree that Community Colleges are where the auxiliaries 

need to be trained, but we have to be the source of the teachers. 

You cannot have an approved school with substandard faculty. 

We need the facilities restored to the original plan of 

our clinical and basic science wing in order that training may be 

14 



offered to those who will teach in our community colleges. 

Our present facilities will not meet this critical shortage 

in instructors for our auxiliary programs in the community 

colleges* The University is where these people turn for help 

in solving this situation and rightly so. 

Dr. E. A. Pearsont Jr.. Director, Dental Division State Board 

of Public Health. 

Dr. Pearson: I would like to thank you for the opportunity 

of speaking to you and I hope to give you the needs from the 

public health viewpoint. 

There are 700,000 children in grades 1 through 6 in 
North Carolina. Six counties have dentists on the staff of 
the local Health Department. There are 140,000 children in 
grades 1 through 6 in these 6 counties, the remaining 560,000 
depend upon the Division of Dental Health for their Dental 
Public Health programs. Of the 560,000, 140,000 of these 
children are classified as medically indigent, and are eligible 
for dental care services which are provided by the State Board 
of Health. Of these 140,000 eligible for care under our pro- 
gram, only 25 to 30 thousand are receiving any service at all 
because we are not adequately staffed. We do into only 46 
counties. One hundred and ten to 115,000 children are in need 
of service. One dentist does some work on about 1700 children 
per year. On this basis 85 to 90 staff dentists are needed to 

15 



provide partial dental care. Our work is different from that 
of a regular dentist in that we have to arrange our schedule 
around the school day. 

Our formula is changing, we are now trying to educate 
these medically indigent children in the prevention of tooth 
decay. ¥e can accomplish a far greater service to the people of 
the State by educating people in the importance of prevention. 
For our job of demonstrative teaching last year, we employed 
23 dentists. This involves referral of the child who is in need 
of care, etc. We have just recently become involved in planning 
programs for othe;r people. Rowan County is the first in North 
to set up a dental program for the chronically ill and aged* We 
have had requests to help elsewhere in the State, but funds are 
not available and where funds are avai^lable, no personnel. 
Education, referrals, follow-ups, topical care should be given 
to the ^imior and Senior High School students of this State. 
This dem^iid is great but we do not have the manpower to provide 
such care. There is an actue shortage in Public Health Dentists. 
Until recent years Public Health Departments have not thought of 
using dental hygienists and, of course, it has been just recently 
that dental hygienists were available. This concept has changed 
and in public health work there is a place for dental hygienists 
in the promoting of dental he*alth programs. Were they available 
and the private needs of the dental profession satisfied, I 

16 



ii^ 



believe we cpuXd provide «iore services ll>y using derttal hygienists* 
(A dental hygienist sisalles teeth, takes X-Rays, applys topical 
application and has a good scientific background as to the health 
needs of the body)t 

We are using every means to attract personnel to this 
ifield, going into the high schools and getting students to devote 
time to helping in dental education. Dental hygien'ists can be 
used to fill the gap in the shortage of Public Health dentists. 

(There was general discussion as to attracting personnel 
and in response to a question from Senator Seay, it was agreed by 
all that this is no problem. The problem is the critical shortage 
in instructors to teach these courses in the commund^ty colleges.) 
Dr, John T. Fulton^ Department otf iEpideiuiloi^y, School of Public 
Health, University of North Carolina . 

Dr. Fulton: The Public Health Sdb^ol at Chapel Hill is a gradua^te 
school. Twenty-five ^percent of ics ^budget comes from State ?funds; 
most of our budget comes from Federal tfunds. We are very much 
concerned and have he^&n for years in the increased ^n^ed for public 
health dentists. ABtso, the increasing need for preventive medicine. 

There are many aspects to this situation. The man who 
goes into Dental Public Health S^ervice onust be selected carefully, 
and necessarily hav^ a high scholastic rating. It is expensive 
in comparison to salaries paid. Public Health Service is a 
surveillance service of the private industry. Though we do have 

17 



scholarships under the Federal Training Program, at the mpinenit 
we have funds to support 5 and we have 15 applicants. 
Dr. William B. Oliver, Chairman^ Dental Assistants Committee t 
North Carolina Dental Society 
(Report attached - Exhibit 1) (Appendix F) 

Dr. Oliver added to the report that again the critical 
problem is obtaining instructors for the two new schools proposed. 
(A dental assistant takes X-Rays , apply topical application and 
works with the dentist) 

Dr. J> Harry Spillman, Chairman of the Dental Hygienists Coimiittee , 
North Carolina Dental Society. 
(Report attached - Exhibit 2) (Appendix G) 

In the discussion that followed relative to shortage in 
instructors, Dr. Spillman advised that retired Army personnel had 
been a source of instructors. Their Army retirement pay supplements 
the low salary scale paid by the community colleges. The Schools 
are accredited by the American Council on Dental Education of the 
American Dental Society. There are three types of accreditation: 
Primary provisional (before class starts); provisional (after the 
class starts); and full accreditation. If these schools operate 
with substandard faculty, they cannot be accredited. If they are 
not accredited, they lose federal money. Students can now take 
State. Boards frou schools having primary provisional accreditation • 
North Carolina is the first state to start dental auxiliary training. 

18 



Mr » 



Other states recognizing this need use our plan in North Carolina 
as a pattern. There are no private institutions in the State 
contemplating operation of dental schools or dental auxiliary 
schools. University of North Carolina was the first school in 
the nation to operate a workshop for dental auxiliary instructors. 

The Dental Assistants School at the Technical Institute 
of Alamance is the only fully accredited school for dental assistants. 
The other two have provisional accreditation. The three Dental 
Hygienists Schools are operating under provisional accreditation. 
The Laboratory Technology School at Durham Technical Institute 
is operating under full accreditation. 

Dr, Colin P. Osborne , Chairman, Dental Laboratory Technician s 
Committee, North Carolina Dental Society. 

Dr, Osborne: We are proud of the Durham Technical Institute. It 
is performing a real service to the dental profession of this State. 
We started this school with opposition from the North Carolina 
Dental Laboratory Association, but relations have improved con- 
siderably* Since this field is fairly new to the profession, we 
feel the school can handle the number of students they are now 
attracting. We are meeting the demand so far in the State. 

(Discussion here as to the value of the school training 
over on-the-job training, and it was the general concensus that 
technicians were better trained and progressed at a more rapid rate 
when they attended school. At school they also have the advantage 

19 



with the dentist, which they do not have when they work in job 
training laboratories.) 

Mr> John Kerr, Director, Health Careers for North Carolina 
(Report attached - Exhibit 3) (Not included in appendix) 

Mr. Kerr added to his report by saying that they go directly 
to the high schools and work with the counselors and students. We 
try to encourage them to write for literature and investigate scholar- 
ships. There has been a 305S increase in applications for health 
careers since the formation of Health Careers for North Carolina. 
Miss Miriam Daughtry, State Supervisor, Health Occupations Dept. 
of Community Collejges. 
(Report attached - Exhibit 4) (Appendix H) 

Miss Daughtr;|jr felt more could be done toward attracting 
personnel to the field of dental assistants. Dental hygienists 
conuiiand a salary of from $600. to $700. per month in comparison to 
$200 for the dental assistant. It was believed that the salary 
of the dental hygienist would eventually adjust itself when the 
demand is met, and the services of trained dental assistants will be 
in more demand when the benefit of their assistance is better known 
and more dentists are trained to use a dental assistant. 

There being no further business the meeting was adjourned at 
1:45 p.m. 



Thomas W. Seay, Jr, 



Patricia A, Benton, Secretary 
Chairman 



n- 



Fred M. Mills, Jr. 20 



THOSE PRESENT AT THE APRIL 16, 1966 HEARING ON SHORTAGES OF 
DENTAL PERSONNEL IN THE STATE . 

mmmmmmm>»mmmmtmm0mamamii^''^"immim^ Uiiii r i i iiiiii*n I naiiifiiiiMin ■ „i^immmmmmmimmmm 

; Miss Miriam Daughtry, State Supervisor, Health Occupations, 
Department of Community Colleges, Raleigh, N* C, 

* Dr. Colin P. Osborne, Chr., Dental Laboratpry Technicians 

^ Committee, N* C. Dental Society, Medical Arts Bldg, tumberton, N. C. 

"^ Dr. James W. Bawden, School of Dentistry, University of N. C, 

^ Chapel Hill, N. C. 



ft 



Dr. John T. Fulton, Dept. of Epidemilogy, School of Public 
Health, University of N» C, Chapel Hill, N. C. 

Dr. Eo Ao Pearson, Jr., Director, Dental Health Division, N. C. State 
Bd. of Health, Raleigh, N. C. 

Dr. William H. Oliver, Dental Assistants Committee, N. C. Dental 
Society, Smithfield, N. C. - Chr. of Committee 

Mr. John T. Kerr, Director, Health Careers for N. C* , Po 0. Box 10937, 
Raleigh, N. C. 

Dr, J. Harry Spillman, Chr., Dental Hygienists Committee, N. C. 
Dental Society, 140 Lockland Ave., Winston-Salem, N. C. 

Dr. Riley )E. Spoon, Professional Bldg, , Winston-Salem, N. C. 



21 



Appendix E 

Repo rt of Dean James W> Bawd en on the Dental Education Win^y at 
„^the S chool of Dentistry, University of North Carolina at Chapel Hill 

The Dental Education Wlngy to be constructed as an addition to the present 
School of Dentistry at the University pf North Carolina at Chapel Hill, was 
originally planned as a four-story, 110,000 square foot structure. The con- 
struction of this facility was planned to provide for Initiation or expansion 
pf various programs as follows; 

!• Increase in D>D^S« class alze ^ The new building will provide the 
resources to increase the siee of the yearly dental class from 50 
Co 75 students* Thici 50% increase in enrollment is of extreme 
importance in meeting the need fpr dentists in the state of North 
Carolina* Approximately 75% of the structure^ was designed in 
direct support of expansion of the D«D«$* program* 
2t Increase in dental hygiene enrollment * The new building would permit 
an increase in the dental hygiene enrollment from 15 to 60 students 
per class* This four* fold increase la necessary in order that the 
School of Dentistry may continue Its present level in training of 
dental hyglenists, and also initiate a substantial program In 
teacher training for inatructors in dental hygiene* The University 
of North Carolina is the only facility in the state which can train 
teachers of dental hygiene to staff existing and projected dental 
hygiene programs in community colleges and vocational schools 
throughout the state* 
3* Development oi: dental assisting program * The dental teaching wing 
is designed to permit the development of a dental assistant training 
program orleni:ed in the direction of teacher training* As in dental 
hygiene, the University of North Carolina is the only institution in 

22 






«r 



^^^. 






¥ 



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4^ 



the state which can properly train dental assistants to teach In the 
various dental assistant training programs throughout the cononunlty 
college and vocational school systeo» In Noipth Carolina* Increased 
facilities would allow an Increase In the number of students In the 
assistant program thus Insuring an adequate base for teacher training 
activities* 
4# Expansion of continuing education programs . Facilities are to be 

provided for a most significant expansion in the continuing education 
programs conducted by the School of Dentistry for the dental practl*^ 



^^ tloners in this state and region. The programs currently conducted 



by the School of Dentistry have an excellent reputation on a national 
basis and are heavily attended. However, limitations on space and 
facilities which now exist preclude any further development of such 
programs. The new building would provide the much needed resources 



\ to conduct programs which are necessary to meet the needs of the 



profession in North Carolina* 
5, Expansion of graduate training . The new structure wais designed to 
permit an increase in the number of graduate students engaged In 
specialty and research training from 15 to 60 students in residence 
each year* The critical need for properly trained specialists in 
* North Carolina has been well documented and the program at the School 

of Dentistry is the state's major resource in meeting this need. 
These graduate programs also provide the teachers to staff this 



4 school, dent:al schools in the southeast, and institutions throughout 

^ ^ the entire nation. 

To construct this facility a grant was applied for and obtained from the U, S« 
^ Public Health Service under Public Law 88-129 (Health Professions Educational 

Assistance Act), The federal grant received was In the amount of $1,546,049, 

23 



A state appropriation o£ $2»293»951waa then made to provide total funding 
of $3,840^000 for the project* Design development drawings proceeded on 
the basis of this funding and In accordance with preliminary designs and 
commitments included in the federal grant* 



delay in time from the first schematic drawings submitted in support 
of the grant application to the time when bids are taken for the 
contract permits a marked escalation in construction costs* An 
already deficient budget was renderiad even more unrealistic due to 
this cost squeeze* 



planned on the basis of existing funds* The University Administration con* 
curred in thla decision and subsequent Trustee action and action by the 



The decision to reduce the project in size required that certain facilities 
and programs be eliminated from the plans* Since the federal grant was awarded 

2^ 



4 






It soon became apparent that the funds in hand were insufficient to construct 
the building as originally designed* The reasons for insufficient funding 
to construct the building as originally planned are twofold: ^ 

1* A dental clinical structure of this type is an enormously complex 
and expensive building* State agencies habitually underestimate 

the square foot cost of such construction and the recommended budget ^ 

for the building was deficient from the very beginning* 
2* Construction costs in the research triatigle area are estimated 

to be increasing at the rate of 1% per month* The considerable ja 



S 



'^ ■ 



After careful consideration^ the administration of the School of Dentistry ^4 
recommended to the University Administration that the situation be anticipated 

and that the building be reduced in size to a three-story » 88,000 square foot ^ ^ 

structure* It was pointed out that such a building could realistically be ^^ 



^ * 



State Department of Administration has resulted in the suggested reduction* • ^^\ 



^ 



IT 



entirely in support of the expansion of the D.D.S. program, and considering 
that it was of extreme importance that the federal grant remain in tact, it 
became necessary to make reductions at the expense of all programs other than 
the D.D«S. curriculum. This meant that any expansion of the dental hygiene 
class was eliminated, proposed expansion of the dental assisting program was 
cut back, all new facilities for continuing education were eliminated, and a 
significant reduction in the graduate programming was indicated. These 
changes in Jeslgn and function have proceeded through approval by the USPHS 
without any change in federal support for the project and all funding is in 
tact. Working drawings for the 88,000 square foot structure are in progress 
and are to be completed by the end of January. 

So important to the health and welfare of the people of North Carolina are 
the functions which have been eliminated from the project, that steps were 
immediately taken to provide for restoration of the building to Its original 
design and function. The reasons for this concerted effort are clear: 

1. The critical shortage of dental hygienists in the state of North 
Carolina demands that the School of Dentistry continue its present 
level of dental hygiene education, expand this program if possible, 

^ and put major emphasis on a teacher training program to provide in- 

structors for other dental hygiene programs throughout the state and 
region. 

2. In the field of dental assisting it is absolutely necessary that all 
resources be developed in the training of dental assistants, and 
that the University provide properly trained teachers for dental 
assistant: programs in North Carolina and the southeast. 

3. In the face of the rapid advancement of scientific knowledge and 
technique, it is mandatory that the continuing education programs 

25 



In the School of Dentistry be greatly expanded* The Unlvetalty pro- 
vides the only major source of continuing education for the dental 
profession in North Carolina* 
4. The need for graduate training In the specialty areas of dentistry is 
of a very critical nature in this state. 
With cokislderatiOQ for these needs, it is estimated that an amount of $1*1 
million will be required to permit construction of the fourth floor of the 
dental education wing, thus restoring the project to its original size and 
scope. The school would then be in a position to provide the various programs 
listed above which are so necessary in meeting the health needs of the popula- 
tion. 

It was also determined that the project is likely to be bid about May 1, 1967, 
or, about one month prior to legislative appropriations. It is planned that 
working drawings for the fourth floor, to include all of the programs which 
have been tentatively eliminated from the project at this time, are to be 
completed and bids are to be taken on this portion of the building as an 
''alternate additive." If the state appropriation is made in early June, and 
funds are made available for the fourth story, the contractor could pick up 
the alternate bid and proceed with construction of the building as a unit* It 
is the firm opinion of the administration of the School of Dentistry that such 
an approach will provide for the most efficient and effective use of state 
funds. * The building will be constructed as a unit with the various components 
arranged in the most useful manner. The construction of the fourth floor 
according to this plan would also result in the minimum square foot cost. 

Agreement by the University and the Department of Administration to permit the 
architect to complete working drawings of the fourth floor required that an 
underwriting fee of approximately $35,000 be provided to the architect In the 

event that state appropriation was not realized • The School of Dentistry 

26 



secured, from its operating budget, approximately $15,000 and then turned to 
the dentists in the state with a request for the remaining $20,000. Working 
through the Dental Foundation of North Carolina, the profession responded In 
a most commendable way by subscribing nearly $33^000 to the project. The 
School of Dentistry has committed only $20,000 of this money to the program 
with the oversubscription serving as security. This expression of support 
by the profession not only permitted the working drawings for the fourth story 
to proceed but also is another example of the dental profession's continuing 
and major support of programs at the University of North Carolina. Three 
hundred dentists in North Carolina participated in this pledge drive. This 
effort was over and above the $320,000 which the Dental Foundation has already 
provided for construction of the Dental Research Building. 

The way is now clear for construction of the Dental Education Wing as 
originally planned, to include all of the programs regarded as absolutely 
necessary in meeting the health needs of the people. If the state appro** 
priation of $1,100,000 is made, the building will be constructed in the most 
efficient and economical manner and should permit the University to provide 
the educational leadership and resources to meet the demands of the dental 
health problem. 

In summary, it should be emphasized that inclusion of teacher training programs 
in dental hygiene and dental assisting serves as the basis for every dental 
assistant and hygiene training program throughout the state of North Carolina. 
At the present time, the number of individuals who are properly trained to 
teach in these programs in the various communities in North Carolina is very 
limited and precUides proper development of such programs. The School of 
Dentistry is the only resource in the state which can properly train these 



27 



teachers and without such a program there Is little chance that the 
auxiliaries, ^ich are so vitally Important to meeting the health manpower 
needs 9 can be trained in adequate nusibers. The programs in the various 
community college and vocational schools depend directly on the funding of 
the fourth floor of the Dental Education Wing. It should be mentioned that 
a grant application of $319,000 has been submitted to the W« K. Kellogg 
Foundation to develop auxiliary teacher training programs in conjunction with 
the coBsmsnity colleges and other institutions. The situation with regard to 
continuing education is equally as important. Without the additional 
facilities the practitioners in this state will have extreme difficulty in 
keeping pace with the new knowledge and techniques which they should be 
assimilating and utilizing to the most effective treatment of their patients. 
The appropriation of the $1,1009QOO in the scope of a project which would total 
nearly $5, 000,000 is a cr:|.tical amount of money which would permit the School 
of Dentistry to approach the problem of dental health care in a comprehensive 
and effective way. Failure to appropriate these funda will most certainly 
lead to a severe problem with regard to the health and welfare of the citizens 
of North Carolina. 



28 






Apuendix F 

NORTH CAROLINA DENTAL SOCIETY 
DENTAL ASSISTANTS COMMITTEE 

William H. Oliver, Chairman 
T. S. Fleming 0. J. Freund 

Charles H. Sugg Gerald Fo McBrayer 

Meetings : This committee has not met since its appointment February 16, 
1966. 

Assignments : This committee was appointed by President Roberts to study, 
analyze and suggest progress of dental assistant training programs* Up 
to this time, one member of the Society has served as liaison with the 
dental assistants. Because the committee was appointed late in the 
administrative year, only the groundwork could be laid before the annual 
meeting. 

Results of Preliminary Study : The following data has been compiled from 
information received from schools offering dental assistant training 
programs . 

Wayne Technical Institute > Goldsboro : A course in dental assisting 
was begun in August, 1963 • As of March 25, 1966, approximately 34 
students have been graduated. There are now 20 students in training. 
The maximum capacity of each class is 12, but it is understood that 
the school could accommodate IS, if necessary. Of the 34 graduates, 
20 are presently employed and 16 have passed the examination of the 
Dental Assistant Certification Board. The one-year program is 
provisionally approved by the ADA Council on Dental Education. 

Technical Institute of Alamance, Burlington : The first class began 
training in September, 1962. To date approximately 33 students have 
been graduated. The maximum capacity of each class is 12, and th^ 
program is operating at maximum capacity. The program is fully 
approved by the ADA Council on Dental Education. 

Central Piedmont Community College, Charlotte : The first class 
entered in September, I964, and to date one class of 9 students has 
been graduated. The maximum capacity of each class is 20 and 20 
students are currently enrolled. This one-year program has been 
provisionally approved by the ADA Coioncll on Dental Education. 

UNC School of Dentistry, Chapel Hill : Information on the dental 
assistant training* program at the UNC School of Dentistry has not 
been obtained. 

Conclusion : The committee feels that with the basic information received, 
the number of dental assistants being graduated is far inadequate to meet 
the demands of the dentists of North Carolina. Even with the basic equip- 
ment cost of $35-40,000 per school, the committee feels that at least 2 
or more schools are needed. The location of the schools can be determined 
only after a survey of individual dentists is conducted. 

Resolutions 

This report is informational in nature and no resolutions are presented. 

Action by House of Delegates : 

29 



Appendix G 

NORTH CAROLINA DENTAL SOCIETY 
DENTAL HYGIENISTS COMMITTEE 

A Report on Current Status of Schools of Dental Hyjgiene and 
Estimated Future Needs 



In answer to a request from The Executive Committee of the NCDS, the 
Dental Hygienists Committee of The NCDS is submitting this report 
as an attachment of its final committee report. 

There are at present two Schools of Dental Hygiene operating in the 
State; The School at Chapel Hill with an annual enrollment of approx- 
imately fifteen and The School at Central Piedmont Community College 
with an annual enrollment of thirty-five to forty girls. In March, 
The School at Wayne Technical Institute in Goldsboro , will begin with 
an initial enrollment of seventeen girls, but this will be raised to 
between twenty and twenty-five €his fall. We have learned that the 
Program in Dental Hygiene at Guilford Technical Institute in James- 
town, N> C. has received its final approval and will begin its first 
program this spring. Their enrollment will be sixty girls for the 
first two year period and approximately twenty girls per year after 
that. 

Our Committee has received a letter from The Dean of The Dental School 
at Chapel Hill in which he states that due to unexpected accelerated 
construction costs, the dental hygiene classes there will remain at 
the current level for the foreseeable futue. Also, the plans at 
Chapel Hill are to place increasing emphasis on the training of stu- 
dents for the Bachelors Degree ( four years ) in order to meet the 

demands for teachers in dental hygiene schools. 

30 



At the current levels of enrollment and allowing for normal attrition, 
the four schools should graduate approximately eighty to one hundred 
dental hygienists per year. 

Our Committee feels that for the immediate future, additional schools 
of dental hygiene should be discouraged. However, we feel that after 
all these schools have graduated their first classes, a reevaluation 
of needs be made. If this further study indicates that the needs 
are not being met, then consideration should be given to starting 
additional schools, or increasing the size of clashes at the existing 
onjs. 

Respectfully submitted, 

J. Harry Spillman, DDS 

Chairman 

Dental Hygienists Committee 



31 



t < 

■* — t 






*, (2) Plan to ex:pand classroom laboratory space to admit 28 students 

I for the first year class in the fall of 1966. 






f« Cost of Equipment - $65,090.00 (State funds) . Federal funds are 
not available for this type of program. 

g. Operating Cost -r 1964-65 

Expenditures; (approximate) 

Supplies $9,288.97 

Travel 471.58 

Consultants* Fees 50.00 

Salaries 15 > 530.06 

$25,340.61 



^ - 7,053.;37 (Inventory) 

Total $18,287.24 



% 



The inventory of supplies, June 30, 1965,' dental gold, platinum, 
semi-precious metals, and precision attachments $2,490.25. Other 

A>, instructional supplies on h^nd $4,563.12. This shows a gross 

inventory of $7,053.37. This subtracted from $25,340,61 shows a 
gross expenditure of $18,287.24. This large inventory is a result 
of quantity buying whicji is necessary to enable us to get the best 
prices o In the case of the gold and other metals, we have a 
reclamation factor which amounts to approximately 90 per cent of 

^^ the expenditure. 



^j^iik> 









G, Summary 

DURHAM TECHNICAL INSTITUTE PROGRAM OF DENTAL UBORATORY TECHNOLOGY IS 
ONE OF THE FIVE PROGRAMS IN THE UNITED STATES THAT IS ACCREDITED BY THE 
COUNCIL ON DENTAL EDUCATION, AMERICAN DENTAL ASSOCIATION. The quality 
of the program is demonstrated by this accreditation. 



The Local Advisory Committee is composed of local dentists, teachers 
from the University of North Carolina School of Dentistry, dental 
technicians and educator^. This is a very active Committee which 
^^ gives active support to this program. 



4 ^ 



' ^ 



The University of North Carolijaa School of Dentistry students work 
^ ^ with the Durham Technical Institute Dental Laboratory students as a 

team for a part of their curriculum. 



^ * 



^^ ' The Durham Technical Institute has planned a workshop, April 21 and 

^ 22, 1966, in cooperation with the University of North Carolina School 

of Dentistry J*or practicing dental laboratory technicians. 



^ # 



33 



This type of educational program does not seem to be well known to 

the people of North Carolina at present; therefore, the Sub-committee .* 

for Dental Laboratory Technology of the State Adviso{ry Committee for jk < 

Education of Dental Auxiliary Personnel feels that the one program 

currently operating at Durham Technical institute be the only one f^ 

sponsored by the Department of Community Colleges* system for the 

next biennium. ^ 

Should the demand by North Carolinians for education in this field ^-i 

be increased, priority for admission into the program will be given 
to these persons* 



It is anticipated for the near future that approximately 25 students 
should graduate from -this program each year. 



4-^ 
p. 

n 
Si 



3^1 



II. DENTAL ASSISTANT EDUCATION ^ 1 year program 

A, Need - There are approximately 1,500 practicing denljists in 

North Ca^rolina, It is estimated that 10 per cent of the practicing 
dentists would require new dental assistants each year, and in 
addition, there will be about 60 new dentists each year; therefore, 
the approximate total need per year of dental assistants would be 
200. This demand is expected to be increased during the next five 
years. (Dental Assistant Sub-committee of State Advisory Committee 
for Education of Dental Auxiliary Personnel.) There are approximately 
72 dental assistant students being graduated annually. 

B, Programs in Progress - 3 

TECHNICAL INSTITUTE OF ALAMANCE 
BURLINGTON, NORTH CAROLINA 

a. Established September 1961 (one class per year) 

b. Graduated - August 1962 -• 11 

August 1963 - 8 
August 1964 - 11 
August 1965 - 12 

U2 

c. Follow-up - -37 replies out of 42; 73 per cent working as 
dental assistants in North Carolina. (Statistics from the 
Technical Institute of Alamance.) 

d. Present Enrollment - 12 to graduate in August 1966. 

e. Glass Capacity - 12 plus 6 in new building (1967). 

f. Cost of Equipment - |37,341.00 (l/2 Federal and 1/2 State funds). 

g. Operating Cost - 1964-65 

Expenditures : (approximate) 

Supplies % 2,011.50 

Salaries 10,297.30 

$12,308.80 
- 2,224.00 Dental Services 

Total #10,084.80 



35 



WAYNE TECHNICAL INSTITUTE 
GOLDSBORO, NORTH CAROLINA 

a. Established September X963 •-- three classes admitted for the year 
of l%Ui two classes per year thereafter, in June and September. 

b. Graduated - August I964 - 7 

February I965 - 6 
June 1965 - 9 
August 1965 - JI 

29 

c. Follow-up - 9 unknown, 20 working as dental assistants; 4 of 
these working out-of-state. (Statistics from Wayne Technical 
Institute.) 

d. Present Enrollment - 19 (9 to graduate in May 1966 and 10 in 
September 1966). 

e. Class Capacity - 12 (classes admitted in June and September - 
2U per year) . 

f. Cost of Equipment - 137,799*00 (l/2 Federal and l/2 State funds). 

g. Operating Cost - 1964.''65 

Expenditures; (approximate) 

Supplies (instructional and office) $ 3,116.4^5 

Travel 922.73 

Consultants' Fees 2,895.00 

Salaries 17,107.76 

Related Classes 2,100.55 

$26,142.49 

- 531 > 00 Dental Services 

Total $25,611.49 



36 



p 



t 



CENTRAL PIEDMONT COMMUNITY COLLEGE 
CHARLOTTE, NORTH CAROLINA 

a. Established September 1964 - admitted one class of nine. 

b. Graduated - August 1965 - 6 

c. Follow-*up - the six graduates are working in North Carolina. 

d. Present Enrollment - 25 (13 to graduate August 1966 and 12 
in December 196?), 



w4 e. Class Capacity - 16 (classes admitted September and December - 

32 per year). 



f. Cost of Equipment - $27,680.00 (l/2 Federal and l/2 State funds), 

g. Operating Cost - 1964-65 

Expenditures: (approximate) 

Supplies $ 1,907.00 (for 6 students) 

Travel 150.00 

Consultants' Fees 1,6^,0.00 
Salaries 10,760.00 

Total $U,^57,00 

C . Summary 

Total 1964-65 graduates - 58, total per year class capacity - 74. 
These figures do not include short-term programs at the University of 
North Carolina, Chapel Hill, 

There are plans for a MDTA dental assistant program at Guilford 
Technical Institute, Jamestown, North Carolina (anticipated 
enrollment of 4-0 for this one-year class). 

The Sub-committee for Dental Assistant Education of the State Advisory 
Committee for Education of Dental Auxiliary Personnel recommended that 
two new dental assistant programs be established in the next biennium — 
one in the far western part of the State where there are no programs 
at present and the other in an area where a siorvey of potential 
vacancies determine it is most needed, Since there is already a 
dental auxiliary education program at the Durham Technical Institute, 
this institution should be considered so that equipment, teaching staff, 
and existing facilities could be used, 



37 



I. DENTAL HYGIENE EDUCATION - 2 year program 

A, Need - No recent figure except the 196^ Survey Ipy N<^rth Carolina Dental 
Society which is not valid at presents There are approximately 125 
practicing dental hygienist in North Carolina. 

B. Programs in Progress - 3 

CENTRAL PIEDMONT COMMUNITY COLLEGE 
CHARLOTTE, NORTH CAROLINA 

a. Established September 1965 '^ 1 class per year 

b. Graduated - none -(August 196?) 
0. Follow-up - none 

d. Present Enrollment - 35 (38 admitted in September 1965) 

e. Class Capacity - 40 

(1) First year students ■-* 40 

(2) Second year students - i^ 

80 

f. Cost of Equipment - |66,579r00(l/2 Federal and X/2 State funds). 

g. Operating Cost - 1965-66 (not available) 



38 



WAYNE TECHNICAL INSTITUTE 
GOLDSBORO, NORTH CAROLINA 

a. Established March 1966 

b. Graduated - none (February 1968) 

c. Follow-up - none 

d. Present Enrollment - 11 (30 to be enrolled September 1966) 

e. Class Capacity - 30 

(1) First year students - 30 

(2) Second year students -- ^ 

60 

f . Cost of Equipment - has not been purchased • Standard estimate 
$65,181,10, (Some equipment can be used -in conjunction with the 
Dental Assistant program, ) 

g> Operating Cost - March 1966 (reflected in Applied Courses only 
for the Spring Quarter). 



39 



GUILFORD TECHNICAL INSTITUTE 
JAMESTOWN, NORTH CAROLINA 

a. Established April 12, 1966 

b. Graduated - none (April 1968) 

c. Follow-up - ngne 

d. Enrollment - plans are to admit 60 students within the next year, 

(1) April 1966 -• 20 

(2) July 1966 - - 20 

(3) October 1966 - 20 

e. Cost - funded by the federal government through the Manpower 
Development and Training Act. First and only Dental Hygiene 
Education program in the United States to be financed by MDTA. 
Present contract for this money terminate-s October 1968. 

C. Summary 

Three Dental Hygiene Education programs total class capacity for 
1965-66 equals 130. (This figure does not include the Dental 
Hygiene program at the University of North Carolina, Chapel Hill, 
North Carolina, which admits fifteen students per year.) 

The Sub-committee for Dental Hygiene Education of the State Advisory 
Committee for Education of Dental Auxiliary Personnel were of the 
general opinion that the four established programs should provide 
adequate numbers of qualified dental hygienist for^/future needs 
of North Carolina. - f' -t- 



:^*1 



1^